Assessment of Extent of Myocardial Injury in Patients Undergoing Transvenous Implantation of Pacemaker Using Cardiac Troponin I (cTnI) as a Marker of Structural Heart Damage and It’s Relation to Different Sites of RV Implantation

Abstract

Abstract Aim and objectives The aim of the study is to assess the extent of myocardial injury in patients undergoing trans-venous implantation of pacemaker using cardiac troponin I (cTnI) as a marker of myocardial injury and it’s relation to different sites of RV pacing and number of screwing. Patients and Methods This study included 50 patients undergoing Trans-venous Implantation of single or dual chamber permanent pacemakers at Ain Shams University Hospitals during the period from February 2020 to August 2020, divided into 2 equal groups according to the site of RV lead implantation, 25 patients RV lead implanted in the Apex and 25 patients RV lead implanted in the Septum. Results All patients had rise in Troponin I after implantation of pacemaker indicating that there is significant relationship between trans-venous implantation of permanent pacemaker and incidence of myocardial injury. Comparing the RV septal pacing group to the RV apical pacing group, results showed that septal RV pacing caused more rise in cardiac troponin I after implantation than in apical pacing group indicating that there is a significant relationship between site of RV pacing and extent of myocardial injury being more in septal RV pacing than apical RV pacing. Furthermore, our study showed that regarding active fixation of RV lead into the myocardium, increasing number of trials of screwing the lead in different sites to achieve the best pacing threshold causes more rise in cardiac troponin I. So, there is a significant relationship between number of screwing and extent of myocardial injury. Conclusion We conclude that trans-venous implantation of permanent pacemakers is associated with an increased incidence of myocardial injury and septal RV pacing is associated with more extent of myocardial injury than apical RV pacing. Also, increasing number of trials of active fixation by screwing the RV leads into the myocardium is associated with more extent of myocardial injury.